Provider Demographics
NPI:1780306787
Name:EMPOWERME DIAGNOSTICS KANSAS CITY, LLC
Entity type:Organization
Organization Name:EMPOWERME DIAGNOSTICS KANSAS CITY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OF EMPOWERME DIAGNOSTICS
Authorized Official - Prefix:
Authorized Official - First Name:TYLER
Authorized Official - Middle Name:
Authorized Official - Last Name:WITGES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:844-502-7996
Mailing Address - Street 1:PO BOX 736005
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75373-6005
Mailing Address - Country:US
Mailing Address - Phone:877-367-9772
Mailing Address - Fax:
Practice Address - Street 1:9001 STATE LINE RD STE 110
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64114-3211
Practice Address - Country:US
Practice Address - Phone:877-367-9772
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-15
Last Update Date:2023-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes291U00000XLaboratoriesClinical Medical Laboratory
No207ZP0105XAllopathic & Osteopathic PhysiciansPathologyClinical Pathology/Laboratory MedicineGroup - Single Specialty